Tuesday, 28 August 2012

Occasionally new meters come along that really interest me and I'd love to give a go to see if they’ll replace the trusted one I use every day. Over the last eighteen months there have been two successful new arrivals for me that have slotted in nicely alongside my trusted Accu-Chek Nano. First came the Accu-Chek Expert that gave me my first introduction to bolus wizardry and really helped to start to bring my levels down onto a level that some would consider to be ‘a little high’. Next up was the Contour Link that arrived with Adam using magic powers and witchcraft to combine with Adam to save having to actually write down the results anywhere. OK, it’s Bluetooth not witchcraft but it’s still magic! Along with them there have been a few disappointments for me including the initial Verio and the iBGStar that I REALLY wanted to become my favourite meter but doubts over the test results meant it returned to the shelf in the bathroom with the rest of my diabetes stash.So up next in the high expectation stakes are the meters I have this week pitched against each other to find a winner in the latest round. In the blue corner we have the Bayer Contour XT which is an update to the previous Contour but promises much tighter error boundaries. And in the red corner is the Mendor Discreet which promises discrete (do you see what they did with the naming there? Clever, eh?) testing in public wrapped up in a very slick package resembling a smartphone.

Getting startedContour – I’ve had a few Bayer meters and the set-up is the usual methodology. The date and time were preset which was nice but the time was an hour out which sort of killed the effort. Darn you British Summer Time. However a quick visit to one of the manuals quickly got that corrected and also highlighted the extra functions available in the Advanced Mode. This includes meal / exercise markers, personal hi/lo settings and summaries, 480 test memory and selectable post-meal reminders. This meter requires no coding as is becoming more common in these modern times.

Discreet – The meter arrives with one lancet inserted with the cap still on and the case open. The time and date were preset (correctly) and once the cap of the lancet was removed the plastic case could be closed it give a package that was of a similar height and width of an iPhone (other smartphones are available – although maybe not in the US!) but about twice as deep.

Comparing the two the size of the pouch/case for the Discreet in your pocket/handbag/manbag is about half the size of the Contour.In useContour – The contour behaves like a very well produced modern meter should. It retains the solid feel of the previous Contour. The huge difference here is the promise of much tighter margins for error. There’s a bigger piece here about this subject but anything that helps to remove the uncertainty of a test is a good thing. Like the Discreet the result is returned after five seconds – is that the meter standard now? It seems to be and to be fair I don’t think there is a great need to go quicker than that. For anyone complaining tsk, tsk, tsk; please revisit the 1980s where tests involved waiting a minute before wiping away the half an armful of blood needed and then waiting another minute before matching to a colour chart by eyesight. Anyway, the added recording options are also good for those who like to do such things. Here is where I hold up my hands and admit that tagging tests as mealtimes, exercise etc is something that I know I’ll not get round to even though it’s a useful-to-know it does require the effort to do. Sorry Bayer and your developers. The Contour came with 10 strips which is good to test general functionality but in relation to accuracy I’ll just have to believe the marketing as I found no proof either way that it was more accurate than the Discreet or my current Nano. Below is a photo of the same blood on multiple strips with very similar results. This occurred on every occasion so reliability showed no advantage in the short-term although that’s not to say there isn’t a longer-term benefit.

(And yes I did take food following this waffy moment before taking the second photo!)

I do like to download my data so it was a little disappointing to see that once again Bayer require the purchase of a cable to get the data downloaded. As I’ve bought one before this isn’t an extra cost for me but for others who are tagging and detailing their records it seems a little cheeky to force them to buy a data cable when the amount spent on strips either directly or through prescription / insurance will be significant.Discreet – Here is where the Discreet earns it’s stripes, or stars or whatever your locality’s mark of respect is. To reveal a strip you pull the lower case down until the strip pops out revealing the bit that needs the blood adding to it. Pull the case down further and it will pop back after priming the stabby-thing ready to extract the blood. Press one button on the front to get the blood, apply the blood, get the result after the standard five seconds. Close both sections of the case and return to whatever you were doing before the need to check arose. Simple, effective and relatively simple to do. The strip cassette comes with 25 strips built in and when you open the case it flashes up how many strips are left. This part is really good unless like me you like to fiddle and decide to remove the cassette to see what it looks like. This automatically resets the counter to 25 – but I guess this is something you’d only do once before realising the error of your ways. And here is where video speaks better than words so it's time for a vid (be warned there is no commentary) ...

So far so perfect, however this is where your opinion on sharps replacement comes into play. I believe the concept of the Discreet is that it’s something you can just throw it in your bag and test ‘Discreetly’ which is fine if you use it once only while out and about. To replace the lancet requires a partial disassemble of the meter to replace the lancet and dispose of the one already in. To me that sort of kills the point of an all in one device. Obviously we all follow our nurses’ advice to change the lancet after every test so we’re used to that anyway. Well, sadly I don’t and my Multiclix can manage for many weeks while I rotate the six lancets until it ‘really’ hurts. I know this isn’t good, but it works for me. The lancet on the Discreet is very fine so whilst giving painfree blood extraction I found it went blunt after 3 stabs. The result was that I carried the meter in my pocket along with a Multiclix for the blood bit. For me this worked OK and was a good compromise but obviously doesn’t give me the full ‘single package’ solution promised by the Discreet. It also mimics the practicality of the Accu-Chek Mobile although it comes in a much, much sexier package. Can a BG meter be sexy? Hmm, Dave needs to get out a bit more! Data download is possible using the supplied USB cable although unfortunately not on a Mac at the moment. This seems a little contrary to the market Mendor appear to be aiming for i.e. young, tech savvy, mobile etc - which I don’t claim to be any of by the way. Riku @ Mendor tells me it’s on the way so I may just be being a bit impatient.Will I continue using?Contour – Not at the moment. And this is with regret. As regular readers will know I have a Medtronic Pump that has a Bluetooth link to my Contour Link. I spoke with a representative of Bayer at a recent exhibition about when the Link would get the next XT strips and was told it’s ‘imminent’ but is dependant on getting approval from Medtronic. When that arrives I think it will jump towards the top of favourite meter list probably replacing the faithful Nano that for some unknown reason maintains it’s position as first choice meter. Although obviously there will be the funding decision with the new strips commanding a premium price for their improved accuracy. I’m aware some GPs local to me are restricting strip provision to certain cheaper manufacturers so this could be a concern.Discreet – This is a difficult one. If I can get approval from my GP to get them on prescription then I think I will. It’s such a ‘cool’ (again, unlike me) design that even though it fails on the blood extraction part I’d be willing to carry a Multiclix just because I wouldn’t need that pain in the bottom canister of test strips rattling around in my bag / pocket.So in my Mortal Meter Kombat Death Match there is one clear winner. In the red corner it’s the Mendor Discreet. Whoop, whoop, whoop. It offers something that’s that little bit different in a package that ‘nearly’ works well. Yes, the blood extracting bit is flawed but the automated strip production in a very snazzy case offers something exciting and new - apart from the Accu-Chek – but it looks a lot better! PS. Reading through before posting this I was thinking about what both meters lack. It’s something that not many have but for anyone testing at night is priceless. I know the Freestyle Lite has one but I’m not sure if others do too. It’s not that hard a concept but for some reason it isn’t catching on. A light. A what? A light. Yep, so that when testing in the middle of the night applying the blood to the strip is a simple operation without waking up anyone else around. And for maybe using the Discreet whilst in a dark location this could be the ultimate funky young things 'D' toy.PPS I know the Accu-Chek Mobile has been doing the one-package thing for a while but I haven't got one of those so can't compare :-PThanks for reading and as always comments appreciated.Dave

Disclaimer - please read!

I am not a medical professional in any way. Nothing on this site should be construed as medical advice. Your diabetes will vary. Contact your health care provider for specific questions and advice. Without sounding like a pharmaceutical company – do not change medication, dosage or philosophy without speaking to your DSN, doctor, consultant or witchdoctor.